Since it has become a sort of epidemic, I feel the need to explain shoulder injuries a bit more extensively.
Asking people who suffer from shoulder pains, they most of the time end with words as ‘tendinitis, bursitis, frozen shoulder’ etc. Now, this does not explain the actual problem, it just states where the level of irritation exists. And even that is some of the time not true (referred pain!).

Let’s do a small recap: the upper arm is connected to the scapula. During movements the two joint parts need to work closely together. At first it is the arm that moves, after 90º the scapula starts to come along. Ergo, the two bones are moved by using specific muscles (e.g. rotator cuff).
The ‘optimum motor control’ of the shoulder is unbelievably complex and sophisticated.

So, if one part is not moving well, it has great repercussions to everything that is attached to the shoulder joint, i.e. tendons, ligaments etc.
Most physical treatments are focused to the local irritation: E.g. tendons, joint play or posture. Unfortunately that is the reason why most treatments of the shoulder fail. You don’t solve this problem because one major part is overlooked at: the scapula function.

As said, the scapula is tremendously important for overhead movements (>90º). A well-known term is an ‘impingment syndrome’, meaning the top of the arm is being squeezed between the scapula and humerus, because the scapula does not move enough. That’s why people end up with total distorsion of movement.

Scapula dysfunction (or dyskinesia) can be differentiated in three different ways while moving:

  1. ‘Tipping’: the inferior angle is sticking out
  2. ‘Winging’: the medial boarder is elevated from thorax (see image on the right)
  3. ‘Shrugging’: the superior angle is elevated

In most cases this is caused by a dysfunction of muscle action (m. trapezius <-> m. serratus anterior). A daily exercise program (8-12 weeks!) can solve this. The program involves mobility of joints, coordination and strengthening of specific muscles and awareness of posture.

So, if your shoulder seems to act ‘strange’, don’t fixate only on rotator cuff discomfort, but take a look at the bigger picture!
And finally my eternal statement: cortisone injections do not solve the problem….


If you would like more information, please contact Bernard Vrijaldenhoven (mob. 91 847 6000) or the International Health Centres in Albufeira (Tel. 289 588 923)